TREATMENT AND INTERVENTION
frequently as more common acts, which is not
 Elder abuse may develop gradually as the:
 Burden of caregiving exceeds the caretaker’s
physical or emotional resources
 Relieving the caregiver stress
 Providing additional resources may help to
correct the abusive situation and leave the
caregiving relationship intact.
 In other cases, the neglect or abuse is
intentional and designed to provide personal
gain to the caregiver, such as access to the
victim’s financial resources.
 In this situation, removal of the elder or the
caregiver is necessary.
RITUAL ABUSE AND TORTURE
 A brutal form of abuse of children,
adolescents and adults,
 Consisting of physical, sexual and
psychological abuse and involving use of
rituals.
 Ritual Abuse rarely consist of a single episode.
 It usually involves repeated abuse over an
extended period of time.
 The physical abuse is severe, including torture
and sometimes killing
 The sexual abuse issue usually painful, sadistic
and humiliating
 Ritual abuse is by definition, not a crime of
impulse, but the crime committed with a
malice aforethought
Forms of ritual abuse
Reported by victims are categorized into four.
1. SEXUAL ABUSE
 Victim of ritual abuse including children of the
youngest ages report being subjected to
bizarre, deviant and extremely painful sexual
activities.
 In addition to combinations of sexual
intercourse. That includes genital anal and
oral between child and adult male or female
and child and child which is force
 Victims report being penetrated vaginally, or
rectally with objects and sometimes being
forced to submit the sexual activity with
animals.
 Research findings based on accounts from the
survivors of ritual abuse indicates that bizarre
and unnatural sexual acts are perpetuated as
the case in non-ritual child abuse.
 Victims of ritual abuse, including children are
tortured in numerous ways.
 They are burned with then cut buried alive
until consciousness is lost, covered with
insects, lock in a freezer until unconscious,
hung upside down, chain curb upon and made
the ingest vile matter included including
blood, urine and faces.
 In connection with sexual abuse. Their bodies
are often twisted and contorted for long
periods of time.
 Survivors report being abused medically and
subjected to electric shocks and drugs of all
kinds.
2. EMOTIONAL ABUSE
 Long Lasting emotional confusion and trauma
result from the following kinds of emotional
abuse as reported by victims.
 Victim state they are forced to participate in
various crimes, including sacrifice of animals,
which may be the children's own pets
 The torture and sometimes murder of babies,
including in some cases, the infants of young
girls required to bear children specifically for
sacrifice,
 The torture and sometimes murder of adults
and their systematic disposal of bodies.
 Some victims report having been forced to
choose which person would be the next
sacrifice. The victims are repeatedly told that
they bad or evil that is their fault, the baby or
pet has to die, that no one will ever love them
or believe them if they report any of this
activities.
 In some instances, according to many reports
children involved in ritual activities are there
because their parents are also part of the
group and have forced the children to
participate from earliest years
 On the other hand, when children are
involved without their parents knowledge,
those boys and girls are lied to told that their
parents actually do not know about the cult
activities and have in fact, given the group
permission to indoctrinate the children.
 Though agreement must never be spoken of
at home. The children are told that if they
disclose any information, their parents or
siblings will be killed.
  According to many accounts, group leaders
program children to believe that they are
always watched, they, they teach children
that no matter where they go, no matter who
they are with their actions and words, indeed,
their very thoughts are known to the group.
 Another aspect of emotional abuse is the dual
socialization of participants, which means
that although outwardly, they have the social
values of community at large.
 Another set of values is being taught by the
group.
 These are inverted values, standard values
turned upside down.
 Doctrine which teach that pain is good,
torture is good. Lying for the cost is righteous
human life is a cheap commodity and so forth.
 Victims report subjection to prolonged and
carefully structured mind controlling or
programming.
 They are conditioned to deny involvement
with criminal abuse, to tell conflicting stories
or retract stories previously reported to harm
themselves if they so much as think about
telling anyone over the coals activities.
 They are convinced that group members have
the power to harm them, even by remote
control if they divulge information.
Spiritual Abuse
 Some deviant color groups make a point of
distorting religious ceremonies, they will
mock the predominant church group of the
area for example, doing black masses and
other distortions of the traditional service in
Catholic locales
 In ritual abuse groups practicing in
predominantly Mormon areas. LDS
ceremonies are copied, distorted and
statistically profound.
 Scriptures and other religious wordings are
perverted rate.
 All group members are subjected to
experiences that mark not only baptism, but
marriage and other ordinances.
 When this victims are later involved in the
legitimate services of the benign religion.
Their program terror is triggered and the
baptism or wedding becomes a nightmare.
 Repeatedly victims report being taught that
God does not love them.
 The proof being that he does not rescue
them, that Satan alone has power to save
them and that no one outside the group will
ever love or trust them.
 Rape and sexual Assault
 Rape is a crime of violence and humiliation of
the victim expressed through sexual means
 the perpetuation of an act of sexual
intercourse with a female against her will and
without her consent, whether her will is our
come by force, fear, drugs or intoxicants.
 It is also considered rape. If the woman is
incapable of exercising rational judgment
because of mental deficiency, or when she is
below the age of consent, which varies among
states from 14 to 18 years.
 The crime of rape requires only slight
penetration of the outer vulva
 full Erection and ejaculation are not
necessarily
 Force acts of fellatio, and anal penetration,
although they frequently accompany rape, are
legally considered sodomy.
 The woman who is raped also may be
physically beaten and injured.
 Rape can occur between strangers,
acquaintances, married persons and persons
of the same sex.
 All those seven states define domestic
violence in a way that excludes same sex
victims.
 Strangers commit about 50% of rapes while
men known to the victims commit the rest.
 A phenomenon called date rape or
acquaintance rape may occur on the first date
or underwrite home from a party, or when
the two people have known each other for
some time.
 It is more prevalent near college and
university campuses. The CDC Division of
Violence Prevention reports that the rate of
serious injuries associated with dating
violence increases with increased
consumption of alcohol by either victim or
perpetrator.
 Rape is highly underreported crime estimates
are that only one rape is reported for every
four to 10 rapes that occur.
 The underreporting is attributed to the
victim's feelings of shame and guilt,
 The fear of further injury and the belief that
she has no recourse in the legal system.
  Victims of rape can be any age reported cases
have range from 15 months to 82 years. The
highest incidence is in girls and women 16 to
24 years of age. Girls younger than 18 years
are the victims in 61% of the rapes reported.
 Rape most commonly occurs in woman's
neighborhood often inside or near her home.
 Some rapes are premeditated, close relatives
of the victims perpetrate 7% of the cases, 10%
in involve more than one attacker
 Rape results in pregnancy about 10% of the
time.
Male rape is significantly underreported crime,
 It can occur between gay partners or
strangers, but it's most prevalent in
institutions such as prisons, or maximum
security hospitals.
 Estimates are that 2% to 5% of male inmates
are sexually assaulted, but the figures may be
much higher.
 This type of rape is particularly violent, and
the dynamics of power and control are the
same as for heterosexual rape.
 Most men who commit rapes are 25 to 40 years
of age, in terms of race 51% are white intent to
rape white victims, and 47% are African American
and tend to rape African American victims.
 The remaining 2% come from other races.
 Alcohol is involved in 34% of cases. Rape often
accompanies other crimes, almost 75% of
Arrested rapists have prior criminal histories
including other rapes, assaults, robberies and
homicides.
Recent research has categorized male rapists into
four.
1. sexual saddest, who are adults by the pain of
their victims,
2. Exploitive predator- who impulsively use their
victims as objects for gratification.
3. Inadequate men-who believes that no
woman would voluntarily have sexual
relations with them and are obsessed with
fantasies about sex.
4. Men for whom rape - is displace, expression
of anger and rage.
Feminist theory proposes that we men have
historically served as objects for aggression, dating
back to when women and children were legally the
property of men.
The following are the warning signs of relationship
violence
1. The person emotionally abuses you. Insults
making belittling comments, acts sulky or
angry when you initiate an idea or activity
2. Tells you with whom you may be friends, or
how you should dress or tries to control other
elements of your life.
3. Talks negatively about women in general,
4. Gets jealous for no reason.
5. Drinks heavily use as drugs or tries to get you
drunk
6. Acts in an intimidating way by invading your
personal space, such as standing too close or
touching you when you don't want him to.
7. Cannot handle sexual or emotional frustration
without becoming angry.
8. Does not view you as an equal.
9. sees himself as smarter or socially superior
10. guards his masculinity by acting tough
11. Is angry or threatening to the point that you
have changed your life or yourself so you
want anger him.
PSYCHIATRIC DISORDERS RELATED TO ABUSE AND
VIOLENCE.
 They are post-traumatic stress disorder or
PTSD
 dissociative disorders
DISSOCIATIVE DISORDERS
 Dissociation is a subconscious defense
mechanism that helps a person protect his or
her emotional self, from recognizing the full
effects of some horrific or traumatic event by
allowing the mind to forget or remove itself
from the painful situation or memory.
Dissociation can occur both during and after
the event. As with any other protective
coping mechanisms, dissociating becomes
easier with repeated use
 Dissociative disorder have the essential
feature of a disruption in the usually
integrated function of consciousness,
memory identity or environmental
perception.
 This often interferes with a person's
relationships, ability to function in daily life
and ability to cope with the realities of the
abusive or traumatic event.
This disturbance varies greatly in intensity in different
people, and the onset may be sudden or gradual,
transient or chronic.
There are four different types of dissociative
disorders,
1. dissociative amnesia,
2. dissociative fugue
3. dissociative identity disorder,
4. depersonalization disorder
DISSOCIATIVE AMNESIA
 The client cannot remember important
personal information, usually of a traumatic
or stressful nature.
DISSOCIATIVE FUGUE
 the client has episodes of suddenly leaving
the home or place of work without any
explanation.
 Traveling to any city and being unable to
remember his or her past or identity.
He or may assume a new identity,
DISSOCIATIVE IDENTITY DISORDER,
 Formerly multiple personality disorder.
 The client displays two or more distinct
identities or personality states that are
currently taking control of his or her behavior.
 This is accompanied by an ability to recall
important Personal Information.
DEPERSONALIZATION DISORDER
 The client has a persistent or recurrent feeling
of being the touch from his or her mental
processes or body.
 This is accompanied by intact reality testing,
that as the client is not psychotic, or out of
touch with reality. survivors of trauma and
abuse who have PTSD or dissociative
disorders often are involved in group or
individual therapy in the community to
address the long term effects of their
experiences.
 Cognitive Behavioral Therapy is effective in
dealing with the thoughts and subsequent
feelings and behavior of trauma and abuse
survivors,
 therapy for clients who dissociate focus
reassociation, or putting the consciousness
back together
 Both Paroxetine (Paxil) and sertraline (Zoloft)
have been used to treat PTSD successfully,
 Clients with dissociative disorders may be
treated symptomatically.
 Clients with PTSD and dissociative disorders
are born in all areas of healthcare from clinics
to primary care offices.
 The nurse is most likely to encounter these
clients in acute care settings, when there are
concerns for their safety or the safety of
others, or when acute symptoms have
become intense and require stabilization.
 Treatment in acute care is usually short term,
with a client returning to community based
treatment as quickly as possible.
ASSESSMENT DATA
During assessment, the following data may be
gathered
 verbalization of inability to cope
 inability to problem solve
 difficulty interpersonal relationships,
 lack of trust,
 self-destructive behavior,
 denial of abuse,
 guilt, fear,
 anxious withdrawn or depressive behavior,
manipulative behavior,
 social isolation
NURSING DIAGNOSIS
1. ineffective coping,
2. inability to form a valid appraisal of that
stressors
3. Inadequate choices of practice responses,
4. Inability to use available resources.
EXPECTED OUTCOMES
Immediate
 The client will express feelings of
helplessness, fear, anger, guilt, anxiety, and so
forth.
 Demonstrate decreased withdrawn
depressive or anxious behaviors, and
  Demonstrate a decrease in stress related
symptoms.
Stabilization
 The client will identify support systems
outside the hospital.
 Continue to express feelings directly,
 Verbalize plans for continued therapy if
indicated.
 While in the community, the client will cope
effectively with stress and stressful lives,
events, participate in treatment for associated
problems, and use community support
systems effectively.
NURSING INTERVENTIONS
 remain aware of the client's potential or elf-
destructive or aggressive behavior and
intervene necessarily
 spend time with the client and encourage the
client to express his or her feelings through
talking, writing, crying and so forth.
 Be accepting of the client's feelings including
guilt, anger, fear, and caring for the abuser.
Clients who are in abusive situations are at
increased risk for aggressive or self-destructive
behavior, including homicide and suicide,
abusive situation engendered a variety of
feeling that the client needs to express
including grief for loss of an ideal, or healthy
relationship, Trust helps hope plans financial
security and home.
 In addition, victims of abuse often feel that
they deserve abuse or it would not have
happened.
 Finally, abuse in relationship does not preclude
failings of caring.
 If the client has been abused, encourage him
or her to talk about experiences involving
abusive behavior. However, do not probe or
push the client to recall experiences. Maintain
a non-judgmental attitude when talking with a
client about this experiences.
 Recalling and retelling traumatic experiences
are part of the grieving process and recovery
from such experiences. However, the feelings
engendered by such recall may create extreme
anxiety and the client may not be ready to face
these feelings.
 Long term supported therapy may be indicated
 Involve the client in group therapy possible,
such as groups of other victims of abuse.
Groups of abusers or mixed groups of abusers
and victims
 Refer the client or resources outside the
hospital if necessary.
 Support groups can help abusers and victims
decrease their sense of isolation and shame.
 increase their self-respect, examine their
behaviors and receive support for change
 The client may feel alone in the abusive
situation.
 Teach the client about abusive behavior.
 Teach the client about the stress of being in an
abusive situation, and about the relationship
between stress and physical symptoms
 Teach the client relaxation and other stress
management techniques.
 Learning about abuse can give the client a
framework with which to begin to identify and
express feelings and face the reality of the
abusive situation.
 The client may need to learn to recognize
stress and develop skills that deal effectively
with stress.
 Help the client identify and contact support
system crisis centers, shelters and other
community resources
 provide return information to the client such
as telephone numbers of these resources,
especially if he or she chooses to return to an
abusive situation,
 Encourage the client to identify and list options
for the future.
 Had the client identify positive and negative
aspects and consequences of this options.
 Encourage the client to discover what he or
she would like and to explore choices.
 Clients in abusive relationship often are
isolated and unaware of support or resources
available.
 Contacting people or groups before discharge
can be effective in ensuring continued contact.
 Clients in abusive relationship often see
themselves as powerless with no options,
desires or choices.
 Help the client arrange follow up care or
therapy.
 Make referrals to therapists support groups or
other community resources as appropriate.
 Family marital or individual therapy may be
indicated provided. The therapist is
knowledgeable about the abuse dynamics
within an abusive relationship and so forth.

 Support or therapy groups are available in

many communities including groups for
battered women through shelters or abuse and
assault centers.
 Survivors of child abuse or incest child abusers,
parent anonymous groups, men who are
abusive men's group to prevent violence
against women and groups for lesbian or gay
men in abusive situation.
 Spend time with a client and encourage the
client to access his or her feelings through
talking, writing, crying and so forth.
 Be accepting of the client's feelings including
guilt, anger, and fear and caring for the abuser.
 When interacting with a client point out and
give support for decision making, seeking
assistance, expression of strengths, problem
solving and successes,
 Recognize the client's effort in interactions,
activities and treatment plan.
 The client may not see his or her strength, or
work as vulnerable and may have suffered
abuse when displaying strength in the past.
 Positive Support may help brand for such
client’s efforts and promote the individual
growth and self-esteem.